Department of Thoracic Surgery, Yao Municipal Hospital, 1-3-1 Ryuge-cho, Yao, Osaka, 581-0069, Japan.
Department of Surgery, Kishima Main Hospital, 3-33 Gakuonji, Yao, Osaka, 581-0853, Japan.
Gen Thorac Cardiovasc Surg. 2021 Aug;69(8):1185-1191. doi: 10.1007/s11748-021-01600-w. Epub 2021 Mar 25.
Accurate histological diagnosis and molecular testing using a sufficient tumor sample of advanced lung cancer, especially non-small cell lung cancer (NSCLC), are crucial for precision medicine. The aim of this study was to assess the feasibility and safety of surgical biopsy for intrathoracic lesions, and, in addition, overall survival after surgical biopsy.
One hundred-one patients who underwent surgical biopsy for intrathoracic lesions of lung cancer at our hospital between 2011 and 2019 were retrospectively reviewed. Their clinical and pathologic records were reviewed. In addition to evaluating the oncologic safety of the surgical biopsy, the overall survival based on the biopsy results was estimated.
The total number of surgical sites of the 101 patients was 131, and common biopsy sites were the lungs (82, 62.6%) followed by hilar/mediastinal lymph nodes (27, 20.6%). There were 13 postoperative complications (12.9%) without surgery-related deaths. The median time from surgical biopsy to the initiation of treatment was 27 days. Appropriate amounts of specimens for diagnosis and molecular testing were obtained from all patients (100%). When limited to treatment-naïve patients with stage IV adenocarcinoma, patients treated with tyrosine kinase inhibitors (TKIs) or immune checkpoint inhibitors (ICIs) based on molecular testing had a better prognosis.
Surgical biopsy for intrathoracic lesions of lung cancer may be a safe and effective method to make a definitive diagnosis, including companion diagnostics for advancing precision therapy in selected patients with inoperable advanced NSCLC.
对于晚期肺癌（尤其是非小细胞肺癌，NSCLC），准确的组织学诊断和分子检测需要使用足够的肿瘤样本，这一点至关重要。本研究旨在评估经胸内病变手术活检的可行性和安全性，以及手术活检后的总体生存率。
回顾性分析了 2011 年至 2019 年期间在我院接受经胸内肺癌病变手术活检的 101 例患者的临床和病理记录。除了评估手术活检的肿瘤安全性外，还根据活检结果估计了总体生存率。
101 例患者的手术部位总数为 131 个，常见的活检部位是肺部（82 例，62.6%），其次是肺门/纵隔淋巴结（27 例，20.6%）。有 13 例术后并发症（12.9%），无手术相关死亡。从手术活检到开始治疗的中位时间为 27 天。所有患者均获得了用于诊断和分子检测的适量标本（100%）。当仅限于未经治疗的 IV 期腺癌患者时，根据分子检测结果接受酪氨酸激酶抑制剂（TKIs）或免疫检查点抑制剂（ICIs）治疗的患者预后更好。
经胸内病变手术活检可能是一种安全有效的明确诊断方法，包括对选定的不可手术晚期 NSCLC 患者进行伴随诊断以推进精准治疗。
